MEDICARE: JEANS RADIOLOGY ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1477500023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEANS RADIOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	101 GREENWOOD AVE
Second Line	:	SUITE 151
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-2627
Country	:	US
Telephone Number	:	215-379-8458
Fax Number	:	215-379-8461

Provider Business Practice Location Address
First Line	:	6579 ROOSEVELT BLVD
Second Line	:	ROOSEVELT PLAZA
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-2918
Country	:	US
Telephone Number	:	215-289-3100
Fax Number	:	215-289-3143

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	VICTORIA SANCHEZ
Credential	:
Telephone Number	:	215-379-8458

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	08/22/2020

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